Eustachian tube function before and after surgery for mucosal chronic suppurative otitis media.

Lisa Mary, Cherian (2012) Eustachian tube function before and after surgery for mucosal chronic suppurative otitis media. Masters thesis, Christian Medical College, Vellore.


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Introduction The Eustachian tube (ET), also called the pharyngotympanic tube, is a narrow passage made of bony and cartilaginous parts connecting the middle ear cleft to the nasopharynx. Normal ET function is necessary for ventilation of the middle ear (ME), maintaining the ME space and drainage of ME secretions. Any structural or functional abnormalities of ET can affect these functions and lead to negative ME pressure, fluid accumulation and, eventually, a perforation of the tympanic membrane. The pathogenesis of mucosal chronic suppurative otitis media (CSOM) is thus believed to be linked to abnormal ET function. Materials and methods This study was performed in the ENT outpatient department at Christian Medical College Vellore, between May 2010 and July 2011. All patients aged 16 years and above with mucosal chronic suppurative otitis media (CSOM), who were scheduled to undergo surgery, were included in the study. A brief history of their problems and clinical findings, were entered into the proforma .Preoperatively otomicroscopic examination, pure tone audiogram, Valsalva maneuver and inflation-deflation test were done. Post operatively after 3 months, otomicroscopic examination, pure tone audiogram, Valsalva maneuver and tympanometry were done. Of a calculated sample size of 104 (180 patients with 40% loss to follow up), 106 patients were followed up. Results Preoperative Valsalva showed that the ET was patent in (54.9%). (62.6%)have blocked ET by the preoperative inflation-deflation test. 72.1% of the patients with a patent ET on Valsalva maneuver showed patent ET on the inflation deflation test also. The association between the 2 tests of ET function preoperatively was high and this was found to be statistically significant (p<0.01). When assessed by Valsalva maneuver and inflation-deflation test preoperatively and tympanometry postoperatively, if a patient had a blocked ET preoperatively there was a higher chance of it changing than if a patient had a patent tube (p<0.001). The success rate of tympanic membrane closure was 78.4%. Although the patients with non-patent ET had a higher rate of residual perforation, when assessed with Valsalva maneuver and inflation deflation test, there was no statistical correlation between preoperative eustachian tube status and postoperative graft status. Conclusion We arrived at 3 important conclusions in this study. Firstly, the ET appeared to be blocked in most patients with mucosal CSOM when assessed preoperatively with the inflation deflation test, whereas most appeared tube patent with the Valsalva maneuver. Secondly, there was a change in the ET function after surgery which was significant (p<0.001) when assessed with both Valsalva and inflation deflation preoperatively and tympanometry post operatively. The function of the ET tends to change from blocked towards patency, possibly due to the removal of the disease and return of normal physiological state after surgery. Finally, there was an increased tendency of a patient with blocked ET to develop a residual perforation, although this did not reach statistical significance.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Eustachian tube function; mucosal chronic suppurative otitis media; pharyngotympanic tube; CSOM
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 12 Jul 2017 12:01
Last Modified: 12 Jul 2017 12:01

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